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NPI Code Detail

MEDICARE: GEOFFREY FOWLER PSY.D

MEDICARE: GEOFFREY FOWLER PSY.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist0810006348VA

General Provider Information

NPI Number : 1417475435
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEOFFREY FOWLER PSY.D
Provider Business Mailing Address
First Line : 9202 CENTER OAK CT
Second Line :
City : MECHANICSVILLE
State : VA
Zip : 23116-2744
Country : US
Telephone Number : 804-207-6737
Fax Number :
Provider Business Practice Location Address
First Line : 199 LIBERTY ST SW
Second Line :
City : LEESBURG
State : VA
Zip : 20175-2715
Country : US
Telephone Number : 703-621-7121
Fax Number : 703-665-7686
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2017
Last Update Date : 10/14/2023

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